When I was in graduate school in the mid-90s, a family hired me to take care of their two-year old son, Jayden. He did not imitate or make any sounds. Jayden was an adorable toddler with autism who preferred to stare at the patterns on his kitchen floor or the spinning fan in his living room. His loving family flew halfway across the country several times a month to learn about the Lovaas method of applied behavioral analysis (ABA).

To get their son to speak, they flew in ABA-trained specialists, who wrote a binder of lesson plans and left them for graduate students like me to carry out. There were four fairly clueless graduate students who implemented the lessons in four-hour shifts. From our combined efforts, their little boy received eight hours of ABA services a day—every day—focused on communication and play.

Our lessons would go something like this: First, I would show Jayden a picture of an ordinary item, such as an apple. Then I would say, “Apple.” If the toddler made an approximated sound, I gave him a mini-marshmallow. We repeated this exercise in succession dozens of times. My novice grad-school self would wonder, “Does this kid understand the experience of an apple? Or does he now think an apple is a marshmallow?”

Twenty years later, I am a school-based practitioner. Eighty percent of my kids are children with autism, a majority with severe communication challenges. I work closely with several board-certified behavioral analysts, and many behaviorally trained paraprofessionals. I’ve developed an understanding of ABA principles, and the realization that reinforcement compels behaviors to continue or change. We all abide by these principles: You go to work, you get money and derive some job satisfaction. Because your duties are reinforcing (some days more than others), you continue to come into work. It is the same with language and ABA: I show you something is worth requesting, and you start to learn to ask for it by whatever means—pictures, signs, gestures—you need to.

Holistic learning

As practitioners, we must re-examine skill mastery. Mastery is beyond 4/5 opportunities in my speech session, or 8/10 trials with a paraprofessional in a cubicle. Skill mastery demands holistic consideration. We learn through schemas—that is, our experiences shape our understanding of the world. If we have no prior knowledge, then our ability to retain that information is reduced dramatically. If I talk about my vacation to the beach, we all produce a somewhat similar multi-sensory image in our head: There’s an ocean or a lake, sand and the various sounds and smells of a beach. Now imagine if you have never been to the beach (or heard of one) and someone shows you a picture. Then they hand you a marshmallow … do you think marshmallow is another word for beach? Have you really learned about a beach?

On occasion, I will inherit an individualized education program chock-full of language objectives written by someone other than an SLP. However, some of the most effective IEPs I have seen have been created through the coordinated efforts of SLPs collaborating with board-certified behavioral analysts.

Here are some good ways to keep meaningful language consideration alive and well when thinking about IEPs, communication, language and ABA principles:

Tease out language versus behavior.

Although language may provide a function, it does not always reduce behavior. This is why it is important for the team to use tools like preference assessments and functional behavior analyses. Little Susie may be pulling your hair because she wants your attention, or perhaps she is pulling your hair because she doesn’t want to wait. In the first example, the SLP could teach the language (e.g., “I want to talk to you.”). But in the second example, teaching the language “I don’t want to wait” may not be sufficient, because the child may act out anyway (picture a two-year-old being told to wait). In this case, a behavioral intervention with something other than words may be more appropriate.

Examine the language-behavior plan connection.

Behavioral support plans are a great way for the team to address behavior in a consistent way. Many behavior plans that come my way are language-laden. This is a great opportunity to work with board-certified behavioral analysts and other team members in refining what language to use with the child at his or her developmental level, while also refining functional communication.

Combine ABA with language and academic goals.

For my students whose IEPs include ABA, one great way to work on generalization through immersion is having the paraprofessional run programs that address “speech and language” goals. For many of my students who have a board-certified behavioral analyst, each goal area on the IEP has an ABA program that corresponds to each objective. I collaborate with the board-certified behavioral analyst on presentation and prompt hierarchies so that we can all agree on the student’s current performance and level of independence. Paraprofessionals take data for each program. Come progress report time, I consult the data collected from staff and combine it with my own. This allows the team to identify discrepancies in how content is delivered, and provides a great opportunity for the team to troubleshoot any issues in terms of skill mastery or curriculum modifications.

Final thoughts.

The overlap between language, communication and behavior is undeniable. Keeping language separate from behavior can ultimately compromise your teaching process’s efficiency. Schools and special education teams need to carve out opportunities for behavioral specialists and speech-language pathologists to collaborate, and think beyond the “reward” of the mini-marshmallow.

Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.